Evaluation of Community Renewal's Area Focus Projects in Edinburgh

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Randomized trial comparing proactive, high-dose versus reactive, low-dose intravenous iron supplementation in hemodialysis (PIVOTAL) : Study design and baseline data

Background: Intravenous (IV) iron supplementation is a standard maintenance treatment for hemodialysis (HD) patients, but the optimum dosing regimen is unknown. Methods: PIVOTAL (Proactive IV irOn Therapy in hemodiALysis patients) is a multicenter, open-label, blinded endpoint, randomized controlled (PROBE) trial. Incident HD adults with a serum ferritin 700 μg/L and/or TSAT ≥40%) or a reactive, low-dose IV iron arm (iron sucrose administered if ferritin <200 μg/L or TSAT < 20%). We hypothesized that proactive, high-dose IV iron would be noninferior to reactive, low-dose IV iron for the primary outcome of first occurrence of nonfatal myocardial infarction (MI), nonfatal stroke, hospitalization for heart failure or death from any cause. If noninferiority is confirmed with a noninferiority limit of 1.25 for the hazard ratio of the proactive strategy relative to the reactive strategy, a test for superiority will be carried out. Secondary outcomes include infection-related endpoints, ESA dose requirements, and quality-of-life measures. As an event-driven trial, the study will continue until at least 631 primary outcome events have accrued, but the expected duration of follow-up is 2-4 years. Results: Of the 2,589 patients screened across 50 UK sites, 2,141 (83%) were randomized. At baseline, 65.3% were male, the median age was 65 years, and 79% were white. According to eligibility criteria, all patients were on ESA at screening. Prior stroke and MI were present in 8 and 9% of the cohort, respectively, and 44% of patients had diabetes at baseline. Baseline data for the randomized cohort were generally concordant with recent data from the UK Renal Registry. Conclusions: PIVOTAL will provide important information about the optimum dosing of IV iron in HD patients representative of usual clinical practice. Trial Registration: EudraCT number: 2013-002267-25.Peer reviewedFinal Published versio

Association of anaemia in primary care patients with chronic kidney disease: cross sectional study of quality improvement in chronic kidney disease (QICKD) trial data

Background: Anaemia is a known risk factor for cardiovascular disease and treating anaemia in chronic kidney disease (CKD) may improve outcomes. However, little is known about the scope to improve primary care management of anaemia in CKD. Methods: An observational study (N = 1,099,292) with a nationally representative sample using anonymised routine primary care data from 127 Quality Improvement in CKD trial practices (ISRCTN5631023731). We explored variables associated with anaemia in CKD: eGFR, haemoglobin (Hb), mean corpuscular volume (MCV), iron status, cardiovascular comorbidities, and use of therapy which associated with gastrointestinal bleeding, oral iron and deprivation score. We developed a linear regression model to identify variables amenable to improved primary care management. Results: The prevalence of Stage 3–5 CKD was 6.76%. Hb was lower in CKD (13.2 g/dl) than without (13.7 g/dl). 22.2% of people with CKD had World Health Organization defined anaemia; 8.6% had Hb ≤ 11 g/dl; 3% Hb ≤ 10 g/dl; and 1% Hb ≤ 9 g/dl. Normocytic anaemia was present in 80.5% with Hb ≤ 11; 72.7% with Hb ≤ 10 g/dl; and 67.6% with Hb ≤ 9 g/dl; microcytic anaemia in 13.4% with Hb ≤ 11 g/dl; 20.8% with Hb ≤ 10 g/dl; and 24.9% where Hb ≤ 9 g/dl. 82.7% of people with microcytic and 58.8% with normocytic anaemia (Hb ≤ 11 g/dl) had a low ferritin (<100ug/mL). Hypertension (67.2% vs. 54%) and diabetes (30.7% vs. 15.4%) were more prevalent in CKD and anaemia; 61% had been prescribed aspirin; 73% non-steroidal anti-inflammatory drugs (NSAIDs); 14.1% warfarin 12.4% clopidogrel; and 53.1% aspirin and NSAID. 56.3% of people with CKD and anaemia had been prescribed oral iron. The main limitations of the study are that routine data are inevitably incomplete and definitions of anaemia have not been standardised. Conclusions: Medication review is needed in people with CKD and anaemia prior to considering erythropoietin or parenteral iron. Iron stores may be depleted in over >60% of people with normocytic anaemia. Prescribing oral iron has not corrected anaemia

Offshore Seismic and Fisheries and Environmental Issues - How Can They be Reconciled?: A Case Study on the Public Review on the Effects of Potential Oil and Gas Exploration Offshore Cape Breton

The author describes the review process preceding the 2003 CNSOPB decision which permitted seismic activities offshore of Cape Breton. The process included a public review conducted by Commissioner Dr. Teresa MacNeil and the subsequent establishment of an Ad Hoc Working Group (part of the CNSOPB\u27s existing Fisheries and Environment Advisory Committee (FEAC)) and a Science Working Group reporting to the Ad Hoc Working Group. In the author\u27s view, the Ad Hoc Working Group arrived at the anticipated result; that is, continued disagreement among the opposing parties on the fundamental issues. Consequently CNSOPB was left with the decision on how to proceed. The author briefly examines the CNSOPB\u27s decision. He concludes that the opposing parties did not move closer together during the review process despite the fact that it was by far the widest ranging review in Canada up to that date. The process did, however highlight the sensitivity of conducting oil and gas exploration in the near-shore environment, the importance of having input into the decision-making process and the need for governments and regulators to provide clear guidelines to all participants in the regulatory review process

Social Aesthetics and Embodied Cinema

During anthropological fieldwork at the Doon School in northern India, my research interests shifted from studying diversity within the school to what I termed its social aesthetics—that is, the distinctive configuration of sensory, social, and material elements that produce a particular experiential environment. Social aesthetics, I came to think, might have as profound an influence on community life as such forces as ideology, economics, and politics. The challenge of how to film this at the school led to several strategies, including focusing on specific themes and physical objects and on the experiences of new students. In exploring the latter, I took advantage of film's capacity to evoke in the viewer a range of sensations beyond sight and sound. This raises the question of whether film can also evoke a film subject's sense of his or her own body—what Charles Sherrington called proprioception. My own experiences of film-viewing, supported by recent discoveries in neuroscience, suggest that it can, both through the film viewer's vicarious identification with those filmed and through the camera's close-range vision within what Aloïs Riegl called "tactile space"

The Age of Reason - The Doon School Quintet (Part 5)

THE AGE OF REASON was made in parallel with THE NEW BOYS and intersects with it at several points. However, instead of looking at the group, it explores the thoughts and feelings of Abhishek, a 12-year-old from Nepal, during his first days and weeks as a Doon student. This is at once the story of the encounter between a filmmaker and his subject and a glimpse of the mind of a child at 'the age of reason'. "It was a remarkable decision to end the Doon School series with this portrait of one child, after having moved progressively closer to it in the earlier, more collective and group-oriented films. The Age of Reason demonstrates once again how respectful MacDougall is of his young subjects in all of these films. This peculiar tact is rare in representations of children's lives and can teach other filmmakers much about ethical concerns and awareness. Here Abhishek, the 12-year-old from Nepal, seems in fact to invite MacDougall to share the actual moments of his emerging self-awareness, as a child becoming a responsible adult. We follow the formation of his patterns of sociability, his emerging agency as a growing adolescent encountering new rituals and social constraints, his personal discoveries, and the processes by which he learns. Never seen simply as an "assimilated" subject, Abhishek shares with the filmmaker, and with an attentive audience, the building up of a particular way of 'reasoning' in the world - as it occurs, and in context." - Rossella Ragazzi, director of the film La Mémoire Dure. "I loved it... elegantly shot, understated, nudging the boundaries between observation and authorial engagement." - Michael Renov, Professor of Critical Studies, University of Southern California; editor of Theorizing Documentary and author of The Subject of Documentary. "Without doubt the Doon Project will provide plentiful material for discussion of such matters as the place of such a school in a democratic society; the acculturation of children; identity in its old sense versus 'identity' in its new sense of national or cultural conformism; how an elite perpetuates its values; or, at a more experiential level, how we may each position ourselves in relation to the machineries of social constraint. Nevertheless, simply to call these anthropological films would, while true, be a little like calling [Chinua Achebe's] Things Fall Apart an anthropological novel. They are major contributions to our screen culture, and deserve to be seen well beyond the confines of the discipline." - Dai Vaughan, Visual Anthropology. ALSO AVAILABLE FROM RONIN FILMS IN THE DOON SCHOOL QUINTET PART 1 - DOON SCHOOL CHRONICLES PART 2 - WITH MORNING HEARTS PART 3 - KARAM IN JAIPUR PART 4 - THE NEW BOY

People and Places – Urban location, social capital and health.

People's health status is strongly related to their socio-economic status. Less well-off people are more likely to have a shorter life expectancy and more illnesses than their richer counterparts. There is also a growing body of research suggesting a relationship between area of residence and health. This project, the Urban Locational Disadvantage, Social Capital and Health Project, was designed to contribute to greater understanding of this relationship with the NHMRC funding support

Social Aesthetics and Embodied Cinema

During anthropological fieldwork at the Doon School in northern India, my research interests shifted from studying diversity within the school to what I termed its social aesthetics—that is, the distinctive configuration of sensory, social, and material elements that produce a particular experiential environment. Social aesthetics, I came to think, might have as profound an influence on community life as such forces as ideology, economics, and politics. The challenge of how to film this at the school led to several strategies, including focusing on specific themes and physical objects and on the experiences of new students. In exploring the latter, I took advantage of film's capacity to evoke in the viewer a range of sensations beyond sight and sound. This raises the question of whether film can also evoke a film subject's sense of his or her own body—what Charles Sherrington called proprioception. My own experiences of film-viewing, supported by recent discoveries in neuroscience, suggest that it can, both through the film viewer's vicarious identification with those filmed and through the camera's close-range vision within what Aloïs Riegl called "tactile space"